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David McGill Blogger

Maintain Your Standards

Posted by David McGill | November 15, 2013

​Federal regulations set forth the standards you must comply with in order to participate in the Medicare program. In this post we focus on 6 of the frequently overlooked or misunderstood DMEPOS Supplier Standards. 

1. Enroll Separate Locations

A prerequisite for Medicare eligibility is that you enroll separate physical locations you use to deliver prosthetics and orthotics to beneficiaries. The only exception to this requirement are sites that you use solely as warehouses and repair facilities. 

2. Report Changes Within 30 Days

When you apply to participate in the Medicare program, your 855S form includes ownership information, the kinds of products you supply to beneficiaries, and your address. If an owner joins or leaves your company, you decide a year after opening to start delivering orthotics in addition to prosthetics, or you open/close a site, you must report those changes to Medicare within 30 days.

3. Don't Bill for Products Covered Under Warranty

You can't charge either the beneficiary or Medicare for the repair or replacement of parts covered under warranty. For components you purchase from manufacturers, check with them for the applicable warranty period. You must also refrain from billing Medicare for 90 days after you deliver the prosthesis or any part of it, unless there's a documented change in the patient's residual limb or functional abilities.

4. Don't Contact Beneficiaries by Phone (Unless)

You can't contact a beneficiary by phone to discuss a Medicare-covered item unless (1) they've given you written permission to do so, (2) you're calling to coordinate its delivery, or (3) you've delivered at least 1 covered item to the beneficiary in the previous 15 months.

5. Maintain Proof of Delivery

As the supplier, responsibility for delivery rests with you and you must maintain proof that the patient received the item(s). In addition, you have to retain documentation showing that the beneficiary received instructions on how to use the item(s) safely. Many of the MAC Reports over the last 2 years have shown that failure to maintain/produce (adequate) proof of delivery accounts for at least 10% of denied claims.

6. Give Your Patients A Copy of the Supplier Standards

Whenever you deliver an item to a Medicare beneficiary, you must also give them a copy of the full list of Supplier Standards. 

Additional Information

In the interest of brevity, this post focuses on only 6 of the 30 Supplier Standards. To see the complete list, click here.

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